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Re-treatment of a lung tumour using a simple intensity-modulated radiotherapy approach

¹ Department of Medical Physics, Hull and East Yorkshire NHS Trust and Clinical Biosciences Institute, University of Hull, Princess Royal Hospital, Saltshouse Road, Kingston Upon Hull HU8 9HE and ² Department of Clinical Oncology, Princess Royal Hospital, Saltshouse Road, Kingston Upon Hull HU8 9HE, UK

We present a lung tumour case where, although the proximal spinal cord had already reached its dose tolerance, re-treatment was indicated. Minimization of the cord dose was defined as the main constraint for this case, however additional dose to the heart was considered. A simple (4 field) intensity-modulated radiotherapy (IMRT) treatment which proved superior to the standard conformal plan was developed using the Computerized Medical Systems (CMS) XiO treatment planning system. The IMRT plan was found to be superior to the conventional conformal plan regarding tumour coverage. It provided 100% saturation of the planning target volume (PTV) by the 95% isodose cloud, whereas the latter only provided 77% coverage. A step and shoot delivery using 10 intensity levels was developed and subsequently delivered for this patient. We considered it to be a routine application of IMRT and an important example of how it can offer benefit in individual and appropriate cases where conventional treatment is inadequate.